Prescription Drugs

Although most people take prescription drugs responsibly, there has been an increase in the nonmedical use or abuse of prescription drugs.

There are three classes of prescription drugs that are most commonly abused:
  • Opiods, which are most often prescribed to treat pain
  • Central nervous system (CNS) depressants, which are used to treat anxiety and sleeping disorder; and
  • Stimulants, which are prescribed to treat the sleep disorder  narcolepsy and attention-deficit hyperactivity disorder (ADHD)
What are opiods? 

Opiods are commonly prescribed because of their effective analgesic, or pain-relieving, properties. Medications that fall within this class – referred to as prescription narcotics – include morphine (e.g., Kadian, Avinza eller hvad de nu hedder I VN, codeine, oxycodone (e.g. OxyContin, Percodan, Percocet), and related drugs. Morphine, for example, is often used before and after surgical procedures to alleviate severe pain. Codeine, on the other hand, is often prescribed for mild pain. In addition to their pain-relieving properties, some of these drugs – codeine and diphenoxylate (Lomotil) for example – can be used to relieve coughs and diarrhea.

How do opiods affect the brain and the body?

Opiods act on the brain and the body by attaching to specific proteins called opiod receptors, which are found in the brain, the spinal cord, and the gastrointestinal tract. When these drugs attach to certain opiod receptors, they can block the perception of pain. Opiods can produce drowsiness, nausea, costipation, and, depending upon the amount of drug taken, depress respiration. Opiod drugs also can induce euphoria by affecting the brain regions that mediate what we perceive as pleasure. This feeling is often intensified for those who abuse opiods when administered by routes other than those recommended. For example, OxyContin often is snorted or injected to enhance its euphoric effects, while at the same time increasing the risk for serious medical consequences, such as opiod overdose.

What are the possible consequences of opiod use and abuse?

Taken as directed, opiods can be used to manage pain effectively. Many studies have shown that the properly managed, short-term medical use of opiod analgesic drugs is safe and rarely causes addiction – defined as the compulsive and uncontrollable use of drugs despite adverse consequences – or dependence, which occurs when the body adapts to the presence of a drug, and often results in withdrawal symptoms when that drug is reduced or stopped. Withdrawal symptoms include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (“cold turkey”), and involuntary leg movements. Long-term use of opiods can lead to physical dependence and addiction. Taken a large single dose of an opiod could cause severe respiratory depression that can lead to death.

Is it safe to use opioid drugs with other medications?

Only under a physician´s supervision can opiods be used safely with other drugs. Typically, they should not be used with other substances that depress the CNS, such as alcohol, antihistamines, barbiturates, benzodiazepines, or general anesthetics, because these combinations increase the risk of life-threatening respiratory depression.

What are CNS depressants?

CNS depressants, sometimes referred to as sedatives and tranquillizers, are substances that can slow normal brain function. Because of this property, some CNS depressants are useful in the treatment of anxiety and sleep disorders. Among the medications that are commonly prescribed for these purposes are the following:

  • Barbiturates, such as mephobarbital (Mebaral) and pentobarbital sodium (Nembutal), are used to treat anxiety, tension, and sleep disorders.
  • Benzodiazepines, such as diazepam (Valium), chlordiazepoxide HCI (Librium), and alprazolam (Xanax), are prescribed to treat anxiety, acute stress reactions, and panic attacks. The more sedating benzodiazepines, such as triazolam (Halcion) and estazolam (ProSom) are prescribed for short-term treatment of sleep disorders. Usually, benzodiazepines are not prescribed for long-term use.
How do CNS depressants affect the brain and body?

There are numerous CNS depressants; most act on the brain by affecting the neurotransmitter gammaaminnobutyric (GABA). Neurotransmitters are brain chemicals that facilitate communication between brain cells. GABA works by decreasing brain activity. Although the different classes of CNS depressants work in unique ways, it is through their ability to increase GABA activity that the produce drowsy or calming effects that is beneficial to those suffering from anxiety or sleep disorders.

What are the possible consequences of CNS depressant use and abuse?

Despite their many beneficial effects, barbiturates and benzodiazepines have the potential for abuse and should be used only as prescribed. During the first few days of taking a prescribed CNS depressant, a person usually feels sleepy and uncoordinated, but as the body becomes accustomed to the effects of the drug, these feelings begin to disappear. If one uses these drugs long-term, the body will develop a tolerance for the drugs, and larger doses will be needed to achieve the same initial effects. Continued use can lead to physical dependence and – when use is reduced or stopped – withdrawal. Because all CNS depressants work by slowing the brain´s activity, when an individual stops taking them, the brain´s activity can rebound and race out of control, potentially leading to seizures and other harmful consequences. Although withdrawal from benzodiazepines can be very problematic, it is rarely life threatening, whereas withdrawal from prolonged use of other CNS depressants can have life-threatening complications. Therefore, someone who is thinking about discontinuing CNS therapy or who is suffering withdrawal from a CNS depressant should speak with a physician immediately or seek medical treatment.

Is it safe to use CNS depressants with other medications?

CNS depressants should be used in combination with other medications only under a physician´s close supervision. Typically, they should not be combined with any other medication or substance that cause CNS depression, including prescription pain medicines, some OTC cold and allergy medications, and alcohol. Using CNS depressants with these other substances – particularly alcohol – can slow both the heart and respiration and may lead to death.

What are stimulants?

As the name suggests, stimulants increase alertness, attention, and energy, as well as elevate blood pressure and increase heart rate and respiration. Historically, stimulants were used to treat asthma and other respiratory problems, obesity, neurological disorders, and a variety of other ailments. But as their potential for abuse and addiction became apparent, the medical use of stimulants began to wane. Now, stimulants are prescribed for the treatment of only a few health conditions, including narcolepsy, ADHD, and depression that has not responded to other treatments.

How do stimulants affect the brain and body?

Stimulants, such as dextroamphetamine (Dexedrine and Adderall) and methylphenidate (Ritalin and Concerta), have chemical structures similar to a family of key brain neurotransmitters called monoamines, which include norepinephrine and dopamine. Stimulants also increase blood pressure and heart rate, constrict blood vessels, increase blood glucose, and open up to the pathways of respiratory system. The increase in dopamine is associated wit a sense of euphoria that can accompany the use of these drugs.

What are the possible consequences of stimulant use and abuse?

As with other drugs of abuse, it is possible for individuals to become dependent upon or addicted to many stimulants. Withdrawal symptoms associated with discontinuing stimulant use include fatigue, depression, and disturbance of sleep patterns. Repeated use of some stimulants over a short period can lead to feelings of hostility or paranoia. Further, taking high doses of a stimulant may result in dangerously high body temperature and irregular heartbeat. There is also the potential for cardiovascular failure or lethal seizures.

Is it safe to use stimulants with other medications?

Stimulants should be used in combination with other medications only under a physician´s supervision. Patients also should be aware of the dangers associated with mixing stimulants and OTC cold medicines that contain decongestants; combining these substances may cause blood pressure to become dangerously high or lead to irregular heart rhythms.

Treating Prescription Drug Addiction

Years of research have demonstrated that addiction to any rug (illicit or prescribed) is a psychical and psychological disease (in fact a “brain disease) that, like any other chronic disease, can be treated effectively. No single type of treatment is appropriate for all individuals addicted to prescription drugs. Treatment must take into account the type of drug used, the number of years it has been used, and the needs of the individual. Successful treatment will need to incorporate several component, including detoxification, counselling, and in some cases, the use of pharmacological therapies. Multiple courses of treatment may be needed for the patient to make a full recovery.

The two main categories of effective drug treatment are the use of the 12-step approach to treatment and pharmacological treatment. 12-step treatment encourage patients ti stop drug use and teach them how to function without drugs, handle cravings, avoid drugs and situations that could lead to drug use, and how to handle a relapse – should it occur. When delivered effectively, 12-step treatment – such as individual counselling, group or family counselling, contingency management, etc. Also, 12-step therapies can help patients improve their personal relationships and their ability to function at work and in community.

Some addictions, such as opiod addiction, can be supported also with medications. These pharmacological treatments counter the effects of the drug on the brain and behaviour, and can be used to relieve withdrawal symptoms, treat an overdose, or even help overcome drug cravings.

Treating addiction to prescription opiods

Several options are available for effectively treating prescription opiod addiction. These options are drawn from research regarding the treatment of heroin addiction, and include medications such as naltrexone, methadone, and buprenorphine, but always supported by 12-step counselling.

Naltrexone is a medication that blocks the effects of opiods and is used to treat opiod overdose and addiction. Methadone is a synthetic opiod that blocks the effects of heroin and other opiods, eliminates withdrawal symptoms, and relieve drug craving. It has been used successfully for more than 30 years to treat heroin addiction. However, it must be remembered that, in a different way, methadone is in itself addictive. Thus, the aim of using methadone in any setting, is to gradually eliminate the drug from the patien´s system.

Buprenorphine is a long lasting, less likely to cause respiratory depression than other drugs, and is well tolerated. However, more research is needed to determine the effectiveness of these medications for treatment of prescription drug abuse.

A useful precursor to long-term treatment of opiod addiction is detoxification. Detoxification in itself is not a treatment. Rather, its primary objective is to relieve withdrawal symptoms while the patient adjusts to being drug free. To be effective, detoxification must precede long-term treatment that either requires complete abstinence or - in the worst case scenario - incorporates a medication, such a methadone or buprenorphine, into the treatment program.

Treating addiction to CNS depressants

Patients addicted to barbiturates and benzodiazepines should not attempt to stop taking them on their own. Withdrawal symptoms from these drugs can be very problematic, and in case of certain CNS depressants, potentially life threatening. Addicted patients must undergo medically supervised detoxification because the treatment dose must be gradually tapered. The 12-step approach to treatment focuses on modifying the patient´s thinking, expectations, and behaviour, while at the same time increasing skills for coping with various life stressors, also has been used successfully to help individuals adapt to the discontinuation of benzodiazepines.

Often barbiturate and benzodiazepine abuse occurs in conjunction with the abuse of another substance or drug, such as alcohol or cocaine. In these cases of polydrug abuse, the treatment approach requires special skills in addressing the multiple addictions.

Treating addiction to prescription stimulants

Treatment of addiction to prescription stimulants, is again often based on the 12-step model that have proven so effective in treating cocaine and methamphetamine addiction. At this time, there are no proven medications for the treatment of stimulant addiction.

Pepending on the patient´s situation, the first steps in treating prescription stimulant addiction may be tapering the drug dosage and attempting to ease withdrawal symptoms. The detoxification process could then be followed by 12-step treatment. 

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